Healthcare Provider Details

I. General information

NPI: 1073744124
Provider Name (Legal Business Name): ORAL SURGERY & IMPLANT ASSOCIATES OF GREENVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ENTERPRISE BLVD SUITE 209
GREENVILLE SC
29615-6301
US

IV. Provider business mailing address

10 ENTERPRISE BLVD SUITE 209
GREENVILLE SC
29615-6301
US

V. Phone/Fax

Practice location:
  • Phone: 864-234-8811
  • Fax: 864-234-8844
Mailing address:
  • Phone: 864-234-8811
  • Fax: 864-234-8844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY JAMES SIMMONS
Title or Position: OWNER
Credential: DMD, MD
Phone: 864-234-8811